Iranian Red Crescent Medical Journal
Year:2021 | Volume:23 | Issue:10|Papers Count:9

Background: To study the effect of dexmedetomidine on oxidative stress response and the expression of intracellular adhesion factor-1 (ICAM-1) and S100B in patients with traumatic brain injury (TBI). Objectives: This study aimed to discusses the effects of dexmedetomidine on oxidative stress response and ICAM-1 and S100B expression in patients with TBI to investigate its protective effect on oxidative stress and brain damage in patients with TBI. Methods: The TBI patients treated in our hospital from May 2017 to April 2020 were enrolled in the study and divided into control and treatment groups by the random number table method. The treatment group was administered with dexmedetomidine injection via an intravenous pump based on the conventional treatment in the control group. Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) were used to evaluate the patients’,injury, recovery, and prognosis. ELISA method was employed to detect four oxidative stress index levels, including serum superoxide dismutase (SOD), lipid peroxidation (LPO), malondialdehyde (MDA), and total antioxidant capacity (TAC), as well as ICAM-1 and S100B levels upon admission and at different time points after the operation. Results: On the 3 rd and 14 th day after the operation, the treatment group had a higher GCS score, compared to the control group (P<0. 05). Furthermore, on the 30 th, 90 th, and 180 th days after discharge, the treatment group had a higher GOS score than the control group (P<0. 05). On the 3 rd, 5 th, and 14 th days after operation, the treatment group had higher SOD activity than the control group (P<0. 05). Immediately after the operation, on the 3 rd, 5 th, and 14 th after the operation, the treatment group had higher LPO levels than the control group (P<0. 05). Moreover, on the 3 rd, 5 th, and 14 th days after the operation, blood MDA levels gradually decreased in both groups, which was lower in the treatment group than that in the control group (P<0. 05). On the 3 rd, 5 th, and 14 th after the operation, the treatment group had higher TAC activity in the blood, compared to that in the control group (P<0. 05). On the 3 rd, 5 th, and 14 th days after the operation, the treatment group had lower S100B levels than that in the control group (P<0. 05). Conclusion: Dexmedetomidine can relieve TBI-induced oxidative stress state and reduce the levels of brain injury markers (ICAM-1, S100B), which has a protective effect on the brain tissue with TBI.

Background: Branding in the field of healthcare services leads to transparency and utility in the type of services, differentiation of services in the minds of patients and their trust in health centers. Objectives: Therefore, the present study was conducted to provide a branding model in the field of healthcare services. Methods: We used a mixed method approach to develop a branding model for providing healthcare services. The study population for qualitative phase included 20 academic and organizational experts using snowball sampling and Delphi technique. For quantitative phase, 830 people referred to health centers were selected as service recipients and 415 medical staff were selected as health care providers. The validity of the questionnaire was confirmed by face, content, and structural validity and its reliability was confirmed by Cronbach's alpha of 0. 96. Quantitative data were presented by EQS software version 6. 1 with confirmatory factor analysis (CFA) and using structural equations. Results: The results of factor structure and measurement equivalence the branding of healthcare services with six main themes of competitive position, brand equity, brand accessibility, brand consolidation in the minds of clients and the market, branding strategies, and consumer-brand relationship in healthcare services branding with 19 sub-themes for clients and providers (CFI= 0. 9, TLI= 0. 8, RMSEA= 0. 085, SRMR= 0. 049) had a good fit and the internal consistency of the items had significant levels(P-value<0/05). Conclusion: According to the research results, the six main themes of competitive position, brand equity, brand accessibility, brand consolidation in the minds of clients and the market, branding strategies, and consumer-brand relationship with 19 sub-themes can be used in the field of health services branding.

Background: Non-suicidal self-injury is a prevalent phenomenon, especially among adolescents, with substantial personal and social consequences. To reduce such behaviors, differential reinforcement of other behaviors has gained substantial empirical support. However, previous investigations on the efficacy of this approach have mostly focused on individuals with developmental disorders, and it is still unknown whether such an approach is a viable treatment option for typically developed individuals. Objectives: This study aimed to investigate the effectiveness of differential reinforcement of other behaviors in reducing non-suicidal self-injury behaviors in typically developed adolescents. Methods: A single-subject A-B-A-B design was used in this study. The statistical population included male adolescents with self-injurious behaviors, the families of whom were seeking treatment for these behaviors. In total, four adolescents were recruited from a psychology clinic in Tehran, Iran, using convenience sampling. Participants were observed at 6, 8, 10, and 12 sessions at baseline phases of A1 and A2, followed by 12 intervention sessions after each baseline phase. The intervention included differential reinforcement of other behaviors. If the participants showed no self-injury behavior within a specific time duration, a reward was provided. Non-suicidal self-injury behaviors included self-harm, hair pulling, severe itching, pinching, wound manipulation, and hand biting. The frequency of these behaviors was assessed during each session. Visual analysis of graphed data, percentage of non-overlapping data, and mean percentage improvement were used for data analysis. Results: The results showed a fairly reliable effect for the intervention on reducing the target behavior, as indicated by a frequency reduction from phase A1 to B1 and A2 to B2 and by a frequency elevation by the intervention withdrawal from B1 to A2. The average percentage reduction across participants was obtained at 56%. However, a low rate of self-injury remained consistent for the participants. Conclusion: The results provided further evidence on the effectiveness of differential reinforcement of other behaviors in reducing selfinjury behaviors. Although the intervention could reduce self-injury substantially, it seemed that it could not eliminate the behavior.

Background: Health literacy refers to the skills and abilities people acquire, analyze, and understand regarding basic health information and services they need so that they can contribute to their health issues and make the right decision. Objectives: Moreover, given the importance of diabetes in the world and in Iran, as well as the impact of health information literacy on the quality of life and control of diabetes, this study aimed to evaluate health information literacy of type 2 diabetic patients and design an information service model for promoting their health information literacy. Methods: In this study, semi-structured interviews were used to collect the qualitative data needed to present the model. In the qualitative method, semi-structured interviews were conducted with 14 health literacy experts selected through purposive sampling. The Grounded Theory method was then used for analyzing interviews and explaining related dimensions and components. Results: In total, five categories (nutritional factors, media development, physical activity, inclusive education, as well as racial and age consciousness) and a core category of "type 2 diabetes recognition" were identified in this study. Conclusion: It was found that diabetes type 2 was heavily influenced by lifestyle and education factors. Finally, according to the interviews, a model was developed to improve the health literacy of diabetic patients.

Background: The tendency to spread to sentinel lymph node (SLN) may differ depending on the biological, clinical, and histopathological features of tumors. If the factors that affect SLN metastasis (SLNM) are known, there may be no need to perform SLN biopsy (SLNB) in some groups. Objectives: This study aimed to investigate the factors affecting SLNM in patients who underwent surgery and SLNB before (surgery group) or after (neoadjuvant chemotherapy group) systemic therapy in the light of current biological characteristics of tumors and patients. Methods: The study included patients who were operated on for breast cancer and underwent SLNB in our institute between 2017 and 2019. The study included a total of 1, 050 patients, who were divided into the surgery (n=900) and neoadjuvant chemotherapy (NAC) groups (n=150). The patients' tumor localization, tumor size, histological subtype, grade, receptor status, lymphovascular invasion (LVI) status, the number of sentinel lymph nodes removed, metastatic lymph nodes in SLNB, and axillary dissection status were analyzed in this study. Results: The study included a total of 1, 050 patients, who were assigned to the surgery (n=900) and NAC groups (n=150). Of the patients, 311 (34. 5%) cases had SLNM. In the surgery group, multivariate analyses showed that grade III, LVI, Her2 (+) increased the risk of metastasis. In the NAC group, the analyses showed Pre-NAC clinical findings of LN metastasis and luminal A subtypes as effective factors. The factors affecting SLNM were analyzed, and the univariate analyses showed that grades II and III, a tumor size of>2 cm, LVI, Her2 (+), and triple negative increased the risk of metastasis. The analyses also revealed LVI as the most important risk factor for SLN metastasis. Conclusion: Knowing the factors affecting SLNM can provide clues for the type of intervention, reconstruction, and radiotherapy planning of patients to be operated on directly or after NAC. In our study, it was found that patient age, tumor size, tumor biology, tumor grade, and especially LVI status were very important in predicting SLN positivity. It is believed that these features should be taken into account when determining the treatment strategy.

Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity. Objectives: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer. Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Ç, ukurova University Medical School Hospital were collected and analyzed retrospectively between Jan uary 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). (The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD g rade >3, respectively. ) Results: The mean+SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56. 38+11. 00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0. 034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups,however, a higher rate of respiratory complications was observed in Group 2 (P=0. 038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2. Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of li fe in patients.

Background: At the end of 2019, the world faced a phenomenon that plunged all human beings into extreme fear and anxiety. A new type of coronavirus began to spread among people around the world, and this was the beginning of one of the greatest pandemics and its problems in the world. Objectives: The present study aimed to study the effect of Emotion-Focused Therapy (EFT) on reducing post-traumatic stress and depression among Covid-19 patients. The statistical population was all English language students at the University of Tehran who had recovered from Covid-19. A total of three students (with a mean age of 22±, 2 years old) were selected from those who had recovered from Covid-19 using convenience sampling. Methods: In this study, a single-subject design was used which was a nonconcurrent multiple baseline design. The EFT protocol was performed during three baseline stages and three stages of ten 90-minute intervention and follow-up sessions. Then the subjects responded to the PTSD Checklist (PCL) and Beck Depression Inventory (BDI). Results: The data were analyzed using visual inspection, Reliable Change Index (RCI), and percentage change formula. The results of the study indicated that the mean improvement of post-traumatic stress variable for the three patients in the post-treatment and follow-up was 42. 39% and 41. 54%, respectively. Additionally, this value for the depression variable was 60. 78 and 60. 22% in the post-treatment and the follow-up. Conclusion: Based on the results of the study, EFT was effective on post-traumatic stress and depression in students infected with Covid19. Therefore, it is recommended to use this treatment to reduce post-traumatic stress and depression in patients with Covid-19.

Background: The miRNAs are referred to small non-coding RNAs (consisting of 18 to 25 nucleotides). Functional studies have shown their functions to be oncogenes or tumor suppressor genes in different types of cancers. The miR-106b and miR-21 have been identified to participate in the biological behaviors of cells. Objectives: This study aimed to evaluate the tissue and plasma levels of miR-21 and miR-106b in patients with breast cancer who were diagnosed with ductal carcinoma. Methods: In total, 40 cases of breast cancer patients 180 samples were examined in this project. Samples included ductal carcinoma breast tumors (n=40), normal breast tissues of the margin of the tumor (n=40) and 20 samples from unaffected mammary tissue of females undergoing reduction mammoplasty (control group), plasma samples of patients with breast cancer (n=40), and plasma of nonaffected individuals (n=40). The expression levels of miR-106b and miR-21 were determined using SYBR Green real-time RT-PCR assay in breast tissues and plasma of cancerous patients in comparison to the controls. Results: MiR-106b and miR-21 revealed much higher expression in tissues and plasma of patients with breast cancer in comparison to that in the group of control (P<0. 001). High levels of mir-106b and miR-21 expression in plasma and tumor tissues were highly correlated with tumors in higher stages and lymph node involvement (P<0. 0001). Conclusion: Based on the obtained results, upregulation of miR-106b and miR-21 in the plasma of patients with breast cancer can act as a possible non-invasive biomarker for breast cancer prognosis. Further follow-up studies are required to confirm this.

Background: Human life is tied with the stress caused by economic, political, social, and cultural problems, which may lead to physical and mental diseases. In such stressful conditions, people make lifestyle changes that put them at high risk for developing hypertension. Objectives: Accordingly, this study investigated the prevention and management of hypertension as a major public health challenge in Iran. Methods: Semi-structured interviews were conducted with managers, health policymakers, social medicine specialists, and faculty members. All interviews were recorded, transcribed verbatim, and analyzed using thematic content analysis. The MAXQDA18 software was applied to facilitate the organization of codes and themes. Results: Interviews were conducted with 17 participants. The analyses resulted in five themes including, educational policies, cultural policies, urban transport policies, organizational policies, and economic policies. A total of 13 subthemes were also extracted from the data. Conclusion: Findings have indicated the stressors factors, stemming from macro-policies and mismanagement of government. To reduce the burden of hypertension and improve people's living conditions, health-oriented policies should be designed and implemented in all sectors.